| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $112.20 | $141.25 | $218.78 | |
Aetna
| Professional | $112.20 | $117.49 | $141.25 | |
Cigna
| Facility | $154.88 | $154.88 | $181.97 | |
Cigna
| Professional | $154.88 | $154.88 | $194.98 | |
Medica
| Facility | $144.54 | $144.54 | $426.58 |